https://doi.org/10.4081/aiua.2023.10928

Early diagnosis and management of arterio-ureteral fistulas: A literature review

Vol. 95 No. 1 (2023)
Submitted: October 11, 2022
Accepted: November 3, 2022
Published: February 22, 2023
Hematuria, Stents, Urinary fistula, Arterioureteral fistula, Endovascular procedures, Angiography
Abstract Views: 965
PDF: 428
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Authors

Pier Paolo Prontera
pierpaolo.prontera@asl.taranto.it
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Carmine Sciorio
Department of Urology, “Alessandro Manzoni” Hospital, Lecco, Italy.
Antonio De Cillis
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Evangelista Martinelli
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Francesco Schiralli
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Marco Lattarulo
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Angelo D'Elia
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Emanuele Utano
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.
Francesco Saverio Grossi
Department of Urology, “S.S. Annunziata” Hospital, Taranto, Italy.

Objectives: Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart useful for an early and effective diagnosis and treatment of this pathology.

Materials and methods: A literature search in PubMed was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers.

Results: A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1%and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diagnostic sensitivity (50%) and endovascular treatment with stent-graft placement across the fistula is the current state of the art treatment choice.

Conclusions: Failure to diagnose can postpone a potentially life-saving targeted therapy and lead to complications. The identifi-cation of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identity-fication of patients at high risk of AUF, who may benefit from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement. 

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
Moschcowitz A. Simultaneous ligation of both external iliac arter-ies for secondary hemorrhage following bilateral ureterolithotomy. Ann Surg. 1908; 48:872-875. DOI: https://doi.org/10.1097/00000658-190812000-00009
Quillin SP, Darcy MD, Picus D. Angiographic evaluation and ther-apy of ureteroarterial fistulas. Am J Roentgenol. 1994; 162:873-8. DOI: https://doi.org/10.2214/ajr.162.4.8141010
Batter SJ, McGroven FJ, Cambria RP. Ureteroarterial fistula: case report and review of the literature. Urology 1996; 48:481-489.
Inoue T, Hioki T, Arai Y, et al. Uretroarterial fistula controlled by intraluminal ureteral occlusion. Int J Urol. 2002; 9:120-121. DOI: https://doi.org/10.1046/j.1442-2042.2002.00433.x
Titomihelakis G, Feghali A, Nguyen T, et al. Endovascular man-agement and the risk of late failure in the treatment of ureteroateri-al fistulas. J Vasc Surg Cases Innov Tech. 2019; 5:396-401. DOI: https://doi.org/10.1016/j.jvscit.2019.06.010
van den Bergh RC, Moll FL, de Vries JP, Lock TM. Arterioureterial fistulas: unusual suspects systematic review of 139 cases. Urology. 2009; 74:251-255.
Takahashi Y, Hirai H, Sassari Y, et al. Successful surgical treat-ment for rapture of an iliac artery aneurysm into a ureter. Ann Vasc Dis. 2009; 2:58-61.
Madoff DC, Toombs BD, Skolkin MD, et al. Endovascular manage-ment of ureteral-iliac artery fistulae with Wallgraftendoprostheses. Gynecol Oncol. 2002; 85:212-217. DOI: https://doi.org/10.1006/gyno.2002.6589
Batter SJ, McGroven FJ, Cambria RP. Ureteroarterial fistula: case report and review of the literature. Urology. 1996; 48:481-489. DOI: https://doi.org/10.1016/S0090-4295(96)00202-6
Puppo P, Perachino M, Ricciotti G, et al. Ureteroarterial fistula: a case report. J Urol. 1992; 148:863-864. DOI: https://doi.org/10.1016/S0022-5347(17)36746-0
Subiela JD, Balla A, Bollo J, et al. Endovascular Management of Ureteroarterial Fistula: Single Institution Experience and Systematic Literature Review. Vasc Endovascular Surg. 2018; 52:275-286. DOI: https://doi.org/10.1177/1538574418761721
Das A, Lewandoski P, Laganosky D, et al. Ureteroarterial fistu-la: A review of the literature. Vascular. 2016; 24:203-7. DOI: https://doi.org/10.1177/1708538115585261
van den Bergh RC, Moll FL, de Vries JP, Lock TM. Arterioureterial fistulas: unusual suspects systematic review of 139 cases. Urology. 2009; 74:251-255. DOI: https://doi.org/10.1016/j.urology.2008.12.011
Fox JA, Krambeck A, McPhail EF, Lightner D. Ureteroarterial fistula treatment with open surgery versus endovascular manage-ment: long-term outcomes. J Urol. 2011; 185:945-950. DOI: https://doi.org/10.1016/j.juro.2010.10.062
Bergqvist D, Pärsson H, Sherif A. Arterio-ureteral fistula: a sys-tematic review. Eur J Vasc Endovasc Surg. 2001; 22:191-196. DOI: https://doi.org/10.1053/ejvs.2001.1432
Matsunaga F, Dambaeva A, Ponsky LE, et al. Systematic Review of the Management of Ureteroarterial Fistulas After Ileal Conduit Urinary Diversion. AJR Am J Roentgenol. 2021; 216:1452-1461. DOI: https://doi.org/10.2214/AJR.20.23132
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018; 23:60-63. DOI: https://doi.org/10.1136/bmjebm-2017-110853
Bietz G, House A, Erickson D, Endean ED. Diagnosis and treat-ment of arterial-ureteric fistula. J Vasc Surg. 2014; 59:1701-1704. DOI: https://doi.org/10.1016/j.jvs.2013.06.015
Takahashi Y, Hirai H, Sasaki Y, et al. Successful surgical treat-ment for rupture of an iliac artery aneurysm into a ureter. Ann Vasc Dis. 2009; 2:58-61. DOI: https://doi.org/10.3400/avd.cr07016
Giordano G, Kyriazi E, Mavridis C, et al. Oncology and compli-cations. Arch Ital Urol Androl. 2021; 93:71-76. DOI: https://doi.org/10.4081/aiua.2021.1.71
Himmel PD, Hassett JM. Radiation-induced chronic arterial injury. Semin Surg Oncol 1986; 2:225-247. DOI: https://doi.org/10.1002/ssu.2980020405
Krambeck AE, DiMarco DS, Gettman MT, Segura JW. Ureteroiliac artery fistula: diagnosis and treatment algorithm. Urology. 2005; 66:990-994. DOI: https://doi.org/10.1016/j.urology.2005.05.036
Tselikas L, Pellerin O, Di Primio M, et al. Ureteroiliac fistula: modern treatment via theendo-vascular route. Diagn Interv Imaging. 2013; 94 :311-318. DOI: https://doi.org/10.1016/j.diii.2012.10.005
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. DOI: https://doi.org/10.1136/bmj.n71
Pillai AK, Anderson ME, Reddick MA, Sutphin PD, Kalva SP. Ureteroarterial fistula: diagnosis and management. AJR. 2015; 204:W592-W598. DOI: https://doi.org/10.2214/AJR.14.13405
Kamphorst K, Lock TMTW, van den Bergh RCN, et al. Arterio-Ureteral Fistula: Systematic Review of 445 Patients. J Urol. 2022; 207:35-43. DOI: https://doi.org/10.1097/JU.0000000000002241

How to Cite

Prontera, P. P., Sciorio, C., De Cillis, A., Martinelli, E., Schiralli, F., Lattarulo, M., D’Elia, A., Utano, E., & Grossi, F. S. (2023). Early diagnosis and management of arterio-ureteral fistulas: A literature review. Archivio Italiano Di Urologia E Andrologia, 95(1). https://doi.org/10.4081/aiua.2023.10928
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